| NPI | 1053971317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME177107) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 57.248346) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2026-06-04 |